The value of Doppler ultrasound in the diagnosis of deep vein thrombosis

Summary

FIFTY-THREE limbs of 50 patients with clinical signs suggestive of deep venous thrombosis (DVT) were examined by phlebography and Doppler ultrasound. With phlebography as a standard, clinical accuracy was 53 per cent compared to 91 per cent using the Doppler technique. DVT was confirmed in 28 phlebograms and was confined to the calf in seven. Diagnosis was made using ultrasound in 95 per cent of those limbs with thrombus located in the popliteal or more proximal deep veins and in 57 per cent of limbs with calf vein thromboses alone. Of 24 limbs without phlebographic evidence of thrombosis one was thought to have a DVT by ultrasound and this false positive result was due to a calf haematoma. Diagnosis by Doppler ultrasound was correct in 10 of 14 limbs (71 per cent) clinically suspected of having calf vein thromboses. There were four false negative results; one due to partial occlusion of a major deep vein and three due to minor thrombi situated in venae comitantes in the calf. The ultrasound technique compares favourably with phlebography in the diagnosis of extensive DVT and is superior to clinical diagnosis alone. Phlebography should be performed where results of the Doppler method are equivocal since partial occlusion of a major vein or minor calf thrombi may give rise to false negative results.